Post Operative Instructions after a Shoulder Replacement

Following your shoulder surgery, hygiene is very important. Due to the lack of movement of your shoulder you will be more prone to sweating and fungal infections in the axilla (armpit). It is also worth considering that you may not be able to wear your usual clothes. It is a good idea to be prepared before your surgery so that you don’t have to go shopping as soon as you are out of hospital.

• Do use an antibacterial soap daily, eg Sapoderm or Gamophen.
• Do use an effective, fast-drying deodorant. Spray-on usually dries faster.
• Do use a tinea powder, (non-spray type), which will help absorb moisture and reduce the chance of a fungal infection such as thrush.
• Do wear loose-fitting clothes, pants that are easy to pull up one-handed and shirts that button up the front, or loose-fitting t-shirts (short sleeve, not singlets) as you want material in armpit region (axilla).
• Ladies may find a pull on or front fastening bra works better.

A sling will be applied in theatre. This is to be left on at all times and will only be removed by the physio, who will show you how to do your post-op exercises.

There will be a large wound pad covering the dressing. This will be removed approximately 12 hours after surgery. The wound dressing will be changed to a waterproof dressing approximately 24-48 hours after surgery.

You can shower but avoid getting water under the dressing. It is to be kept dry for as long as possible.

You will be given a post-operative appointment upon discharge as you will need a review appointment 10-12 days after surgery. If you do not have this appointment, please contact the rooms on 08 8376 9988.

Driving after surgery

Due to safety and insurance, driving is not permitted for 8 weeks following surgery or unless you have been given clearance by Dr Nimon prior.

Pain management

Pain relief or a script will be provided to you upon discharge from the hospital. This amount should be adequate, however you may need to take “over the counter” pain relief for the next few weeks. It is not unusual to experience some pain for several weeks following surgery.

If you have any concerns such as swelling, redness, increased warmth of the operation site, excessive discharge from the wound or you have a temperature and are generally feel unwell, please contact Dr Nimon immediately on 08 8376 9988 or after hours paging service 8378 2179.

It is important to carry out post-surgery exercises as shown by the physiotherapist while your shoulder is healing. These exercises can be carried out as able or 3-4 times a day. We recommend taking some pain relief 30 minutes prior to commencing exercises.

Shoulder Exercises

Whilst sitting with your arm in the sling, place your feet wide apart and bend forward at your waist, allowing your arm to gently drop forward. Cradle your operated arm and gently move it in circles with the assistance of your other arm.

Elbow Exercises

Whilst lying with your operated arm supported by a pillow, loosen the sling straps. From the resting position, simply move the hand of your operated shoulder towards chin, thus bending your elbow as far as able. When straightening, simply take hand down across stomach, pelvis and down to side as far as able.

Wrist Exercises

With the arm in a resting position across your stomach, turn your palm up and then down. Then, in the resting position with palms facing up, move your wrist up and down. It is very important to keep the hand moving as it may be swollen, and this will prevent it from getting stiff. Make a full fist, stretching your fingers out.

Showering

A separate sling will be given for showering. When showering, wear this sling and lean on a wall or soap dish with the elbow, allowing the arm to passively come away from the body. Your axilla (armpit) can then be washed with your other arm. Then do the same on drying. Put spray-on deodorant on after to reduce potential bacterial load and then tinea powder (not spray-on) in the axilla to avoid moisture and reduce the chance of thrush developing. After, put on a t-shirt (loose fit). Do not wear singlet/sleeveless shirts etc as skin on skin will lead to thrush/irritation in armpit. Put operated arm through the sleeve, then head and then opposite arm and put blue sling on over the top.

Post Operative Exercises – Physiotherapy Instructions

Immediate: Post-op Elbow, hand range of motion (ROM), neck exercises

2 Weeks: Internal and external rotation exercises – avoiding external rotation past neutral. Assisted elevation (ie. stick, pulley).

4 Weeks: Sling should be abandoned. Therapeutic assisted abduction. Therapist assisted or auto assistance. Isometric rotator cuff strengthening within limits of pain.

6 Weeks: Increase range of motion.

2 – 3 Months: Increasing power of internal and external rotation and abduction (ie. Theraband). Proprioceptive work. Scapular exercises.